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Background: Assessment of physicians’ communication skills with patients is essential to ensure effective treatment. Achieving such a goal requires the use of a valid, native, and culturally-based tool. This study aimed to design a physician-patient communication skills assessment tool and evaluate its validity and reliability among the medical students of Guilan University of Medical Sciences, Rasht City, Iran. Methods: In this cross-sectional, descriptive, and analytical study, out of 400 medical students (interns), 300 were selected by a stratified random sampling method. The initial tool with 30 items was evaluated by calculating the item impact index in the target group. Also, its ratio and content validity indexes were assessed by 10 experts’ views and factor analysis. The reliability of the research tool was confirmed by assessing the internal consistency by calculating the Cronbach alpha value. Results: Out of the 30 initial items, after calculating the item impact score index of higher than 1.5, the content validity ratio greater than 0.51, the content validity index higher than 0.79, and exploratory factor analysis,18 items remained and were considered suitable for the physician-patient communication skills assessment tool. Then, these variables were loaded considering the amount of special value greater than 1 under four factors. The reliability of the research tool was confirmed by calculating the Cronbach alpha coefficient of 0.92. The instrument was also confirmed by confirmatory factor analysis regarding its appropriate fitness indices. This study provided a proper and native instrument with 18 valid and reliable items for the assessment of physician-patient communication skills in medical students. Conclusion: The results of this study could be of interest to researchers in evaluating physician-patient communication skills in other medical sciences universities of Iran.

Integration of simulated practice with art-based teaching strategy can be effective for learning communication skills. This pilot study outlines the effect of integrating simulation with art-based teaching strategies on the attitudes of oncology fellows toward learning communication skills. The study was conducted in Iran using a quasi-experimental method. The participants were the oncology fellows of Tehran University of Medical Sciences (n = 19). The intervention was 1-day workshop, followed by integrating simulation with different types of art-based teaching methods. The Communication Skills Attitude Scale (CSAS) was used to assess the effectiveness of the developed model. Our finding indicated that the mean values of oncology fellows' attitude scores in all domains of CSAS including importance in medical context (53.26 ± 2.13vs 41.00 ± 5.01, p = 0.001), excuse (25.84 ± 3.01vs14.36 ± 2.62, p = 0.001), learning (23.26 ± 1.40vs8.89 ± 2.25, p = 0.001), overconfidence (13.10 ± 1.44 vs 5.57 ± 1.38, p = 0.001), and overall (115.47 (5.51) vs 69.84(6.51) p = 0.001) increased significantly after the intervention as compared with before it. Findings support the hypothesis that using integrated training methods may help oncology fellows to appreciate the importance of communication skills learning. The implications of this hypothesis are that the inclusion of integrating simulation with art-based teaching strategies in the medical curriculum can improve the attitude of oncology fellows during their education.

Background: Standardized patient (SP) has been applied to measure learner’s communication challenges such as breaking bad news (BBN). When utilizing SP-based assessment, 2 steps should be considered in SP training; assessing SPs portrayal as the real patient (authenticity) and how SPs checklist fill out reproducibility. Objectives: In this study, we described the process of training authentic and consistent SPs for evaluating oncology fellows’ performance regarding BBN in Iran. Methods: In this cross-sectional study, 8 eligible SPs took part in a 3-day educational meeting. Four different scenarios were developed regarding cancer patients along with corresponding checklists representing common presentations of illness. The accuracy of SPs portrayal was evaluated by experts, using a previously validated rating scale during observation of their role-playing. The reproducibility of SPs’ portraits was measured, using a test-retest approach. The inter-rater agreement of the SPs’ ability to fill out the BBN scale was measured by comparing the correlation between the SPs, who completed the scale, and oncologist faculty members’ judgments, which is considered a gold standard. Results: The findings of this study indicated that the cut-off score for the SPs’ portrayal validity was 95%. The reliability of SPs portrayal was acceptable (r = 0.89). The inter-rater agreement between SPs and experts in filling the BBN scale (k = 0.82), as well as, the consistency of filling the BBN scale between SP groups were highly acceptable (k = 0.86). Conclusions: The present study has demonstrated that if SP is trained appropriately, they shave a high degree of reliability and validity to assess oncology fellows’ performance regarding BBN skills.

To compare the performance of the general practitioners (GPs) in a collaborative care (CC) program in Iran with a control group of GPs in the usual care by employing simulated patients. Six trained simulated patients (SPs) made unannounced visits to 26 GP offices participating in the CC program and to 26 age and sex matched controls. The SPs role played five clinical scenarios of mental disorders and filled out checklists to evaluate the GPs’ performance regarding interviewing, taking history, establishing rapport, showing empathy, and giving advice to patients. Additionally, the GPs’ plan of care and prescriptions were evaluated later by a psychiatrist based on the documents provided by the SPs. There was a significant difference between collaborative care and control group physicians in their global performance; CC physicians built up better patient–physician relationship. They performed better in evaluating a psychotic patient, although not better in their management. CC physicians were marginally better in approach to patients with generalized anxiety disorder (GAD) and mild major depressive disorder. The overall performance of physicians in CC was better than the GPs in the control group in making an effective patient–physician relationship, and evaluating a psychotic patient. The main weakness of the GPs was in proper treatment of the minor and more common psychiatric disorders and in evaluation of patients with suicidal ideations who were in need for emergent referral. Evaluating performance of the practitioners is feasible employing SPs and the findings can be translated into improvements in the available services.

The task of breaking bad news (BBN) may be improved by incorporating simulation with art-based teaching methods. The aim of the present study was to assess the effect of an integrating simulation with art-based teaching strategies, on fellows’ performance regarding BBN, in Iran. The study was carried out using quasi-experimental methods, interrupted time series. The participants were selected from medical oncology fellows at two teaching hospitals of Tehran University of Medical Sciences (TUMS), Iran. Participants were trained through workshop, followed by engaging participants with different types of art-based teaching methods. In order to assess the effectiveness of the integrating model, fellows’ performance was rated by two independent raters (standardized patients (SPs) and faculty members) using the BBN assessment checklist. This assessment tool measured seven different domains of BBN skill. Segmented regression was used to analyze the results of study. Performance of all oncology fellows (n = 19) was assessed for 228 time points during the study, by rating three time points before and three time points after the intervention by two raters. Based on SP ratings, fellows’ performance scores in post-training showed significant level changes in three domains of BBN checklist (B = 1.126, F = 3.221, G = 2.241; p

This study aimed to assess the effectiveness of an interprofessional education model (IPE) based on the transtheoretical model to improve the participants' interprofessional collaborative practice. The study was conducted in Iran using a controlled before-and-after study design. The participants (n = 91) were the residents of emergency medicine and nurses of the emergency units from two teaching hospitals affiliated to Iran University of Medical Sciences. The participants in the intervention group (n = 40) were 22 residents and 18 nurses. The control group (n = 51) consisted of 20 residents and 31 nurses. The participants were classified based on their stage of readiness to change. The interventions were two-day workshops for each stage (i.e., attitude and intention). We used the Interprofessional Collaborator Assessment Rubric (ICAR) to assess the effectiveness of the developed model. The interprofessional collaboration of the participants in the intervention and control groups was assessed at four time points before and after the intervention in the real emergency unit environment. Student's t-test and repeated measures analysis of variance (RM-ANOVA) were used to analyse the data. We used partial eta-squared (η

مقدمه: آموزش و یادگیری، همواره به عنوان یک فرایند دو جانبه مطرح بوده است و سبک های یادگیری، که عادات پردازش اطلاعات دریافتی افراد می باشد، یکی از عوامل مؤثر در یادگیری است. توجه اساتید و برنامه ریزان در سطوح مختلف آموزش به سبک های یادگیری، موجب تسهیل فرایندهای آموزش و یادگیری خواهد شد. این مطالعه با هدف تعیین سبک های یادگیری دانشجویان علوم پزشکی گیلان در رشته های مختلف تحصیلی انجام شد. روش ها: این مطالعه توصیفی -مقطعی، بر روی 407 دانشجوی دانشگاه علوم پزشکی گیلان در رشته های مختلف تحصیلی به روش نمونه گیری تصادفی طبقه ای انجام گرفت. جهت جمع آوری اطلاعات از پرسشنامه اطلاعات دموگرافیک و سیاهه سبک یادگیری کلب استفاده شد، که روایی و پایایی آن در مطالعات مختلف تائید شده بود. پس از جمع آوری اطلاعات با استفاده از نرم افزار Stata و بهرمندی از آمار توصیفی و آمار تحلیلی (آزمون مجذور کای و آنالیز واریانس یکطرفه)، تجزیه و تحلیل شد.

Aims: Understanding the strengths and weaknesses of educational environment can help managers to improve the educational system. The aim of this study was determining the gap between students’ perceptions and expectations of the educational environment at Health School of Hormozgan University of Medical Sciences in Iran. Methodology: In this cross-sectional study a total of 250 health students were studied. To determine the students’ perceptions and expectations they filled out a questionnaire included 56 pairs of five point likert scaled items with six domains including school atmosphere, teaching and learning, teachers, students’ self perception, educational facilities and equipments and the physical environment. Descriptive statistics and paired ttest were used to evaluate and analyze the data by SPSS ver.19. Results: In all of the domains of educational environment, the students’ expectations of Original Research Article British Journal of Medicine & Medical Research, 4(35): 5657-5666, 2014 5658 the educational environment were significantly higher than their perceptions (p

Rational and objectives To assess the effects of a tailored and activating educational intervention, based on a three-stage modified Prochaska model of readiness-to-change, on the performance of ge ...

Background:Breaking bad and unpleasant news by physician to patient or his or her family is a key moment in communication between a physician and the patient. It is often necessary for physicians to breaking bad and unpleasant news to the patient or his or her family. The objective of this study was to evaluate the skill of general physicians in breaking bad and unpleasant news to the patient based on the SPIKES questionnaire in educational hospitals of Qom University of Medical Sciences in 2016.Methods:This descriptive-analytical study was conducted on 200 general physicians. Convenient sampling method was used in this study. Data were collected using standard Spikes Questionnaire and data were analyzed by using descriptive and inferential statistical tests through SPSSv21 software.Results:Most of the subjects were male (69.5%), married (85.1%), and had no history of receiving formal education about breaking bad news to the patient. The mean and standard deviation of the subjects were 37.43±4.02 years. The mean and standard deviation of the score of the skill of breaking bad news were 63.56 ± 6.51. While independent t test showed significant difference in mean and standard deviation of score of the skill of breaking bad news between the two groups (p 0.05). Moreover, using variance analysis, a significant difference was found in mean score of breaking bad news in different age groups with different employment history (p

The Prochaska model of readiness to change has been proposed to be used in educational interventions to improve medical care.To evaluate the impact on readiness to change of an educational intervention on management of depressive disorders based on a modified version of the Prochaska model in comparison with a standard programme of continuing medical education (CME).This is a randomized controlled trial within primary care practices in southern Tehran, Iran. The participants included 192 general physicians working in primary care (GPs) were recruited after random selection and randomized to intervention (96) and control (96). Intervention consisted of interactive, learner-centred educational methods in large and small group settings depending on the GPs' stages of readiness to change. Change in stage of readiness to change measured by the modified version of the Prochaska questionnaire was theThe final number of participants was 78 (81%) in the intervention arm and 81 (84%) in the control arm. Significantly (P0.01), more GPs (57/96 = 59% versus 12/96 = 12%) in the intervention group changed to higher stages of readiness to change. The intervention effect was 46% points (P0.001) and 50% points (P0.001) in the large and small group setting, respectively.Educational formats that suit different stages of learning can support primary care doctors to reach higher stages of behavioural change in the topic of depressive disorders. Our findings have practical implications for conducting CME programmes in Iran and are possibly also applicable in other parts of the world.

Objective To assess the validity and reliability of an 11-item questionnaire for stages of readiness to change according to a modified Prochaska model (including attitude, intention and action stage) in the context of continuing medical education (CME) on depressive disorders for general practitioners (GPs) in Tehran, Iran. Methods Three hundred and fifty GPs were recruited for filling in a questionnaire in order to assess content validity and modifying the questionnaire. Fifty-nine GPs were involved for testing reliability and 39 GPs for testing concurrent validity. Content validity of the questionnaire was assessed by expert consensus. Concurrent validity was assessed by correlating the results of a semi-structured interview with those of the self-assessment questionnaire. For testing reliability there was a test–retest approach with an interval of 3–7 days. Results A panel of experts was held at four times and the final version of modified Prochaska questionnaire (MPQ) was compiled by the panel. Total κ coefficient for concurrent validity of the whole questionnaire was 0.80. Only two of the questions had a κ coefficient lower than 0.70. In the test–retest, 96% of participants reassigned to the same stage and the total κ coefficient of reliability was 0.89 for the whole questionnaire. Conclusion The validity and reliability of the MPQ for assessing GPs’ readiness to change in the field of depressive disorders were found to be high in the Iranian context. These findings support its application in tailoring and evaluating CME programmes for GPs in Iran.

(2015) Journal of Nursing ManagementThe effects of intervention based on supportive leadership behaviour onIranian nursing leadership performance: a randomized controlled trialAims To assess the effects of a workshop on supportive leadership behaviour(SLB) on the performance of head nurses, using a randomized controlled trialdesign.Background The effect of transformational leadership on SLB in nursingmanagement is emphasised.Methods A total of 110 head nurses working at university hospitals wereincluded randomly in two control and intervention groups. The head nurses inthe intervention group participated in supportive leadership training, but thecontrol group did not. Performance in supportive leadership was assessed with avalidated instrument, which six subordinates used to assess their head nurse(n = 731).Results There was a significant difference in SLB scores from baseline to the3 month follow-up (P < 0.0001). Moreover, the post-intervention scores weresignificantly higher in the intervention group, compared with the control group(P < 0.0001). The results showed that in the intervention group, the effect sizeswere greater for males (50%) than for females (36%) and greater for marriedparticipants (42%) than for single participants (37%).Conclusion The workshop on supportive leadership behaviour, particularly theinteractive multifaceted training, improved the leadership performance of thehead nurses who participated in this study.Implications for nursing managers Health policy decision makers should applySLB, which is a significant leadership style, to improve the outcomes in othergroups of health-care management, such as physicians. Future studies are neededto investigate the effects of such workshops in longer periods of follow up.Keywords

Rationale, aims and objectives Balancing administrative demands from the medical school while providing patient support and seeking academic advancement can cause personal hardship that ranges from high stress to clinically recognizable conditions such as burnout. Regarding the importance of clinical faculties' burnout and its effects on different aspects of their professional career, this study was conducted and aimed to evaluate the relationship between willingness to change teaching approaches as characterized by a modified stage-of-change model and measures of stress and burnout. Methods This descriptive analytic study was conducted on 143 clinical faculty members of Tehran University of Medical Sciences in Iran. Participants were asked to complete three questionnaires: a modified stages of change questionnaire the Maslach Burnout Inventory and the General Health Questionnaire. Data were analysed by SPSS: 16 using non-parametric statistical tests such as multiple regression and ICC (intra-class coefficient) and Spearman correlation coefficient test. Result A significant relationship was found between faculty members' readiness to change teaching approaches and the subscales of occupational burnout. Specifically, participants with low occupational burnout were more likely to be in the action stage, while those with high burnout were in the attitude or intention stage, which could be understood as not being ready to implement change. There was no significant correlation between general health scores and stage of change. Conclusions We found it feasible to measure stages of change as well as stress/burnout in academic doctors. Occupational burnout directly reduces the readiness to change. To have successful academic reform in medical schools, it therefore would be beneficial to assess and manage occupational burnout among clinical faculty members.

The objective structured examination is one of the most valid, reliable, and effective tools for assessing clinical and communication skills, often by use of standard patients (SPs). SPs can also be assessors of those skills. One of the crucial areas when utilizing SP-based assessment is the quality and consistency assurance of their portrayal of the case and their ability to fill in checklists in an adequate way. The aim of this study was to assess the validity and reliability of SPs’ ability to assess students’ communication skill via a Calgary-Cambridge checklist. This cross-sectional and correlational study was conducted at the Tehran University of Medical Science. We first analyzed validity; the criterion validity of the SPs’ filling in the checklists was assessed through determining the correlation between the SPs’ completed checklists and the checklists filled in by three physician raters individually and then reproducibility: it was assessed by a test-retest approach inter-rater reliability. The mean correlation for assessing the validity of SPs’ completed checklists by individual SPs was 0.81. The inter-rater reliability was calculated by kappa coefficient, and the total correlation among the three raters was 0.85. The reliability of the test-retest approach showed no significant differences between the test and re-test results. The increased number of medical students and different faculties’ responsibilities such as doing educational, research, and health services duties assessing medical student communication skills is a complex issue. The results of our study showed that trained SPs can be used as a valid tool to assess medical students’ communication skills, which is also more cost effective and reduces work load of medical faculties.

Background: Traditional approaches in Continuing Medical Education (CME) appear to be ineffective in any improvement of the patients' care, reducing the medical errors, and/or altering physicians' behaviors. However, they are still executed by the CME providers, and are popular among the majority of the physicians. In this study, we aimed to explore the parameters involved in the degree of effectiveness of CME program in Iran. Methods: In this study, 31 participants, consisting of general practitioners, CME experts and providers were recruited to participate in in-depth interviews and field observations concerning experiences with CME. Application was made of the qualitative paradigm along with the qualitative content analysis, using grounded theory data analysis methodology (constant comparative analysis). Results: Based on the participants' experiences, the insufficient consistency between the training program contents and the demands of GPs, in addition to the non-beneficiary programs for the physicians and the non-comprehensive educational designs, created a negative attitude to the continuing education among physicians. This could be defined by an unrealistic continuing education program, which is the main theme here. Conclusion: Impracticable continuing education has created a negative attitude toward the CME programs among physicians so much that they consider these programs less important, resulting in attending the said programs without any specific aim: they dodge absenteeism just to get the credit points. Evidently, promoting CME programs to improve the performance of the physicians requires factual needs assessment over and above adaptation of the contents to the physicians' performance.

Objective: The objective of this study is to describe the process of training valid simulated patients (SPs) for assessing communication and counseling skills of pharmacy students' performance. Methods: This is a cross-sectional and correlational study. Psychometric properties of checklist and SPs' portrayals and their filling of the checklist regarding assessing pharmacy students were assessed. Five SPs who were working in the simulated patient's pool were volunteered to take part in the project, which one of the SPs failed. Three scenarios, along with corresponding checklists, were developed based on the usual medications of different diseases consisting of asthma, respiratory infections, and osteoporosis. The SPs' role-play performance was video-recorded and rated independently by two experts according to an observational rating scale to assess validity. The role-play was repeated after 1 week with the same scenario and the same doctor, to assess test-retest reliability. The inter-rater agreement between SPs and experts was determined by calculating the intraclass correlation coefficient and kappa coefficient. Findings: The four eligible SPs were all women, with an average age of 37 years. The correlation between mean scores of raters and mean scores of SPs was 0.91 and 0.85, respectively. The Pearson's correlation between mean scores of raters with SPs was 0.75. The checklists' reliability, Cronbach's alpha, was calculated to be 0.72. The measured weighted Cohen's kappa for the ratings of by each SP, and the gold standard was between 0.53 and 0.57, indicating a moderate agreement. The inter-rater reliability kappa coefficient between raters was 0.75 (P = 0.01). Conclusion: The authors have demonstrated the technique of using standardized patients to evaluate communication and counseling skills of pharmacy students. The findings indicated that trained SPs can be used as an effective tool to assess pharmacy students' communication and counseling skills.

Standardized patients (SPs) have been developed to measure practitioner performance in actual practice settings, but results have not been fully validated for psychiatric disorders. This study describes the process of creating reliable and valid SPs for unannounced assessment of general-practitioners’ management of depression disorders in Iran. Ten psychology and nursing students (potential SPs) took part in a five-session course involving training in dialogue and body language. Five scenarios, along with corresponding checklists representing common presentations of mood disorders in primary-care settings, were developed by an expert group. The SPs’ role-play performance of their respective scenario was videotaped and scored independently by three psychiatrists according to an observational rating scale to assess validity. The role-play was repeated after 1 week with the same scenario and the same doctor, to assess test-retest reliability. The reliability of each checklist to be used by the SPs was assessed by testing interrater reliability between groups of SPs. The cutoff score for the SPs’ portrayal validity was 90% or above for all SPs. Mean interrater reliability for the checklists was acceptable for the SPs watching the same videos and filling in the checklists, while the mean kappa for assessing concurrent validity in filling in the checklists was lower. The test-retest performance for assessing reliability resulted in a mean kappa of 0.72. All SPs except one, who was not recruited, performed acceptably well. The authors have demonstrated a thorough validation of the technique of using standardized patients in the portrayal of depressive disorders in primary-care settings in Iran, which creates confidence in employing this technique to evaluate doctors’ performance, for example, after an educational intervention. Similar methods of validation can be used for SPs’ portrayal of other psychiatric disorders.

Background: The fact that general practitioners (GPs) find it difficult to detect and treat depression is a worldwide concern. This is also the case in Iran, where this study was conducted. Educational interventions have been used to support GPs in their work when treating patients with depression disorders. Objective: To explore GPs' views regarding macro level barriers of the management of depression in primary care settings. Methods: In this qualitative study, semi-structured interviews exploring GPs’ views, beliefs and experiences regarding the diagnosis and treatment of depression were done. A purposeful sampling to obtain a broad range of views was carried out among GPs that had previously participated in an educational intervention study. Eleven GPs were interviewed and their views were probed in depth to get rich descriptions to ensure trustworthiness of the data. The data were analyzed by using qualitative content analysis. Results: GPs’ beliefs regarding macro level barriers emerged as 2 significant themes Organizational and Society-Related factors . The Organizational factors included barriers related to the local health network system and organizational support and the Society-Related factors included economic, cultural and social factors. The individual GP´s opinions about management strategies seemed not to be related to their perceptions of macro level barriers. Conclusion: The results of this study imply that a number of macro level obstacles were of great importance when managing patients with depression disorders. In order to improve the effectiveness of CME events they should be tailored for the actual context and the infrastructural issues that is, organizational and societal factors should be addressed.